Departments of Neurology and Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, and Neurology Service, Neurobehavior Unit, Los Angeles, CA, United States; U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, United States.
Int J Law Psychiatry. 2023 Jul-Aug;89:101909. doi: 10.1016/j.ijlp.2023.101909. Epub 2023 Jul 17.
The responsibility of persons with brain disorders who commit offenses may depend on how their disorders alter brain mechanisms for culpability. Criminal behavior can result from brain disorders that alter social cognition including a neuromoral system of intuitive moral emotions that are absolute (deontological) normative codes and that includes an emotion-mediated evaluation of intentionality. This neuromoral system has its hub in the ventromedial prefrontal cortex (VMPFC) with other frontal, anterior temporal-amygdalar, insular, and right temporoparietal connections. Among brain disorders, investigators report offenses in persons with brain tumors, epilepsy, and traumatic brain injury, but it is those with a form of dementia with VMPFC pathology, behavioral variant frontotemporal dementia (bvFTD), who are most prone to criminal behavior. This review presents four new patients with bvFTD who were interviewed after committing offenses. These patients knew the nature of their acts and the wrongness of the type of action but lacked substantial capacity to experience the criminality of their conduct at the intuitive, deontological, moral emotional level. Disease in VMPFC and its amygdalar connections may impair moral emotions in these patients. These findings recommend evaluation for the experience of moral emotions and VMPFC-amygdala dysfunction among persons with antisocial behavior, with or without brain disease.
患有脑障碍的犯罪者的责任可能取决于其障碍如何改变其对罪责的大脑机制。脑障碍会导致犯罪行为，这些障碍会改变社会认知，包括一个直觉道德情感的神经道德系统，该系统是绝对（义务论）规范准则，包括对意图的情感介导评估。这个神经道德系统的中心在腹内侧前额叶皮层（VMPFC），与其他额叶、前颞叶-杏仁核、岛叶和右颞顶叶连接。在脑障碍中，研究人员报告了脑肿瘤、癫痫和创伤性脑损伤患者的犯罪行为，但最容易发生犯罪行为的是 VMPFC 病变、行为变异额颞叶痴呆（bvFTD）的患者。这篇综述介绍了 4 名新的 bvFTD 患者，他们在犯罪后接受了采访。这些患者知道自己行为的性质和行为的错误类型，但缺乏在直觉、义务论、道德情感层面上体验自己行为犯罪性的实质性能力。VMPFC 及其杏仁核连接的疾病可能会损害这些患者的道德情感。这些发现建议对具有反社会行为的人，无论是否有脑疾病，评估其体验道德情感和 VMPFC-杏仁核功能障碍的情况。
